Category: Trauma

Categories
Anesthesia Equipment and Technology Clinical Tips Leadership in Emergencies Trauma

#127 – The use of TEG 6s in Trauma Resuscitation – Nathan Bowser

Nathan Bowser, BSN, RN, RRNA

My guest today is Nathan Bowser, a 3rd Doctor of Nursing Practice resident in the University of Arizona‘s nurse anesthesia program.

Nathan is the lead author on a paper published in the August 2026 edition of the AANA Journal titled “Use of Thromboelastography 6s in Trauma: An Integrative Review for Anesthesia Providers.” In this article Nathan and his co-authors outline the literature pertinent to Haemonetic’s new TEG 6s device, which presents substantial advances over their older TEG 5000 device.

This new device is one of several in the market that bring thromboelastography to the point of care, which has significant implications for improving targeted transfusion during trauma resuscitation.

Nathan and I walk through the clinical context of trauma resuscitation, in which up to 30% of severely injured patients arrive to the hospital in a trauma-induced coagulopathy (TIC). He then walks us through how having a cartridge-based point of care TEG device can speed time to transfusing the products your patient actually needs. The device is also useful for reducing the total number of blood products delivered and helping clinicians know when to slow down or even stop transfusion.

At the end of the show, we talk a bit about Nathan’s process and motivation as a DNP resident to push his doctoral project through to submitting for publication and then producing this podcast.

If you’re in to trauma resuscitation, blood product management or curious about how to find topics for and structure your DNP or residency project, this is a great show for you.

Huge shout out to Nathan Bowser for putting the work in and to Dr Kristie Hoch, the program director at the University of Arizona’s nurse anesthesiology program for connecting Nathan and me. If you’re a critical care RN considering anesthesia training, definitely take a look at the University of Arizona’s program – Dr Hoch has been at the helm for years and has been working hard to develop the program and support her doctoral students.

In other news, our CRNA team at MaineHealth just got back from the AANA Annual Congress in Boston a few weeks ago. We were thrilled to see a bunch of old friends and to meet the future of our profession in all of the nurse anesthesiology trainees and critical care nurses at the conference.

I’m also looking forward to a seeing some of you at Encore Symposium’s fall conference in Bar Harbor, Maine in October and then in O’ahu, Hawaii in November. I’ve committed to join Encore again next October back at the Cliff House so if you’re looking for a 2027 conference to attend, scope out the scene with Encore Symposium’s conference at the Cliff House in Maine next October.

And with that, let’s get to the show!

Resources from Nathan:

General review of Viscoelastic devices-

https://pmc.ncbi.nlm.nih.gov/articles/PMC9903681

Thromboelastography on fixed wing-

https://pmc.ncbi.nlm.nih.gov/articles/PMC11272443

Fibrinolytic shutdown-

https://journals.lww.com/journalacs/abstract/2024/07000/differentiating_pathologic_from_physiologic.5.aspx

https://journals.lww.com/journalacs/abstract/2017/04000/persistent_fibrinolysis_shutdown_is_associated.34.aspx

https://pmc.ncbi.nlm.nih.gov/articles/PMC4443855

https://journals.lww.com/journalacs/abstract/2016/04000/acute_fibrinolysis_shutdown_after_injury_occurs.2.aspx

Cell-based Model for Hemostasis

The Cell-Based Model of Coagulation

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Categories
Leadership in Emergencies Preparing for Grad School/Residency Trauma

#88 – Combat Trauma Anesthesia with Dustin Degman, MSN, CRNA – Part 3

This is episode 88 and it’s part 3 off a three-part series with Dustin Degman, a CRNA formerly with the United States Army.

In the first episode, we discussed Dustin’s experience in Afghanistan serving at a forward operating base in Paktika Province in 2012.  We talk about what makes up forward surgical teams and the role of CRNAs as the sole anesthesia provider on these teams.

In part two, we discussed the principles of damage control resuscitation.

And in this final episode of the series, we talk about the path to becoming a military CRNA, a little bit more about Dustin’s personal journey and the importance of supporting our troops. Now, I know the wars in Iraq and Afghanistan have fortunately come to an official end and that right now in August of 2022 we are in a period of time where United States troops are not in active combat roles. However, the United States still have the world’s largest military with approximately 1.3 million active service members and nearly 200,000 personnel actively deployed oversees. What Degman shares in this episode about how to engage with and support active service personnel is a powerful message for each of us. These individuals continue to make a sacrifice to serve the mission that our nation has given them. That we support them and how we support them matters. And so we’re going to talk a bit about that in this episode. And again, in terms of direct relevance to anesthesia, this episode has incredible traction for those of you who are or want to become military CRNAs or physician anesthesiologists or those of you who work with, are friends with or in families with these individuals.

This series was originally recorded in early 2015, just a year or so after Dustin had returned from Afghanistan and while the war there was still raging.  At the time, I was completing my anesthesia training at Western Carolina University and working on launching From the Head of the Bed… the podcast the preceded Anesthesia Guidebook.  Dustin was one of my professors and clinical faculty at WCU and was kind enough to volunteer his time for these interviews back then.  The reason I’m bringing them forward here is that they’re chock full of wildly fantastic details on the experience of a forward-deployed military anesthesia provider and the principles of trauma anesthesia, which are absolutely relevant today.

Dustin served with the Unites States Air Force from 1998 – 2002 as a critical care Registered Nurse.  He was honorably discharged and went on to complete his anesthesia training outside of the military.  In 2010, he re-enlisted with the Army Reserves as a CRNA and was deployed in November 2012 to Forward Operating Base Orgun-E in Paktika Province, Afghanistan where he was the sole anesthesia provider on a forward surgical team providing damage control resuscitation to injured soldiers.  Most recently, Dustin serves as the chief CRNA at PeaceHealth’s Peace Harbor Medical Center in Florence, Oregon.  In 2021, Dustin was awarded the PeaceHealth Mission & Values award and the organization put together an incredible video tribute to Dustin.  Degman is the real deal… he was the real deal a decade ago when he was serving in Paktika Province, Afghanistan, which he talks about in these next 3 episodes and he’s still the real deal as he serves as a CRNA with Peace Harbor Medical Center out on the coast of Oregon.

I think you’re going to really enjoy hearing from Dustin on combat trauma anesthesia and with that, let’s get to the show!

To close each of these 3 episodes out, I’d like to encourage you to make a donation to the Pat Tillman Foundation in honor of Army Ranger Pat Tillman who was killed in Afghanistan in 2004.  The Pat Tillman Foundation awards academic scholarships to military service members, veterans and their spouses.  Dustin Degman identified this as one of the several service organizations that he believes in and encourages you to give to either the Pat Tillman Foundation or an organization you connect with.  If we each give $10-20, our collective impacts will make a huge difference.

Resources:

Care behind the battlefield
Dustin Degman was featured in Asheville’s Mountain Express in 2013.

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Categories
Airway Anesthesia Equipment and Technology Clinical Tips Human Physiology and Pathophysiology Leadership in Emergencies Pharmacology Trauma

#87 – Combat Trauma Anesthesia with Dustin Degman, MSN, CRNA – Part 2

What’s up yall this is Jon Lowrance with Anesthesia Guidebook.  I am so pumped to bring you this series of 3 episodes on Combat Trauma Anesthesia!  

This is episode 87 and it’s part 2 off a three-part series with Dustin Degman, a CRNA formerly with the United States Army.

In the first episode, we discussed Dustin’s experience in Afghanistan serving at a forward operating base in Paktika Province in 2012 to 2013.  We talk about what makes up forward surgical teams and the role of CRNAs as the sole anesthesia provider on these teams.

In this part – part two, we discuss the principles of damage control resuscitation in the context of forward surgical bases and combat zones. While this discussion is focused on combat trauma anesthesia, the core underlying principles of damage control resuscitation hold true for civilian trauma centers.

And then in part three, we’re gonna come back and talk about the path to becoming a military CRNA and the importance of supporting our troops.  

This series was originally recorded in early 2015, just a year or so after Dustin had returned from Afghanistan and while the war there was still raging.  At the time, I was completing my anesthesia training at Western Carolina University and working on launching From the Head of the Bed… the podcast the preceded Anesthesia Guidebook.  Dustin was one of my professors and clinical faculty at WCU and was kind enough to volunteer his time for these interviews back then.  The reason I’m bringing them forward here is that they’re chock full of wildly fantastic details on the experience of a forward-deployed military anesthesia provider and the principles of trauma anesthesia, which are absolutely relevant today.

Dustin served with the Unites States Air Force from 1998 – 2002 as a critical care Registered Nurse.  He was honorably discharged and went on to complete his anesthesia training outside of the military.  In 2010, he re-enlisted with the Army Reserves as a CRNA and was deployed in November 2012 to Forward Operating Base Orgun-E in Paktika Province, Afghanistan where he was the sole anesthesia provider on a forward surgical team providing damage control resuscitation to injured soldiers.  Most recently, Dustin serves as the chief CRNA at PeaceHealth’s Peace Harbor Medical Center in Florence, Oregon.  In 2021, Dustin was awarded the PeaceHealth Mission & Values award and the organization put together an incredible video tribute to Dustin.  Degman is the real deal… he was the real deal a decade ago when he was serving in Paktika Province, Afghanistan, which he talks about in these next 3 episodes and he’s still the real deal as he serves as a CRNA with Peace Harbor Medical Center out on the coast of Oregon.

I think you’re going to really enjoy hearing from Dustin on combat trauma anesthesia and with that, let’s get to the show!

To close each of these 3 episodes out, I’d like to encourage you to make a donation to the Pat Tillman Foundation in honor of Army Ranger Pat Tillman who was killed in Afghanistan in 2004.  The Pat Tillman Foundation awards academic scholarships to military service members, veterans and their spouses.  Dustin Degman identified this as one of the several service organizations that he believes in and encourages you to give to either the Pat Tillman Foundation or an organization you connect with.  If we each give $10-20, our collective impacts will make a huge difference.

Resources:

#83 – Positive Deviance as a Catalyst for Change with Cherie Burke, DNP, CRNA

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Categories
Anesthesia Education Clinical Tips Leadership in Emergencies Trauma

#86 – Combat Trauma Anesthesia with Dustin Degman, MSN, CRNA – Part 1

What’s up yall this is Jon Lowrance with Anesthesia Guidebook.  I am so pumped to bring you this next series of 3 episodes!  

This is episode 86 and it kicks off a three-part series with Dustin Degman, a CRNA formerly with the United States Army on combat trauma anesthesia.  

In this first episode, we discuss Dustin’s experience in Afghanistan serving at a forward operating base in Paktika Province in 2012 to 2013.  We talk about what makes up forward surgical teams and the role of CRNAs as the sole anesthesia provider on these teams.

In part two, we discuss the principles of damage control resuscitation and the context of operating in a combat zone.

In part three, we talk about the path to becoming a military CRNA and the importance of support our troops.  

This series was originally recorded in early 2015, just a year or so after Dustin had returned from Afghanistan and while the war there was still raging.  At the time, I was completing my anesthesia training at Western Carolina University and working on launching From the Head of the Bed… the podcast the preceded Anesthesia Guidebook.  Dustin was one of my professors and clinical faculty at WCU and was kind enough to volunteer his time for these interviews back then.  The reason I’m bringing them forward here is that they’re chock full of wildly fantastic details on the experience of a forward-deployed military anesthesia provider and the principles of trauma anesthesia, which are absolutely relevant today.

Dustin served with the Unites States Air Force from 1998 – 2002 as a critical care Registered Nurse.  He was honorably discharged and went on to complete his anesthesia training outside of the military.  In 2010, he re-enlisted with the Army Reserves as a CRNA and was deployed in November 2012 to Forward Operating Base Orgun-E in Paktika Province, Afghanistan where he was the sole anesthesia provider on a forward surgical team providing damage control resuscitation to injured soldiers.  Most recently, Dustin serves as the chief CRNA at PeaceHealth’s Peace Harbor Medical Center in Florence, Oregon.  In 2021, Dustin was awarded the PeaceHealth Mission & Values award and the organization put together an incredible video tribute to Dustin.  Degman is the real deal… he was the real deal a decade ago when he was serving in Paktika Province, Afghanistan, which he talks about in these next 3 episodes and he’s still the real deal as he serves as a CRNA with Peace Harbor Medical Center out on the coast of Oregon.

I think you’re going to really enjoy hearing from Dustin on combat trauma anesthesia and with that, let’s get to the show!

To close each of these 3 episodes out, I’d like to encourage you to make a donation to the Pat Tillman Foundation in honor of Army Ranger Pat Tillman who was killed in Afghanistan in 2004.  The Pat Tillman Foundation awards academic scholarships to military service members, veterans and their spouses.  Dustin Degman identified this as one of the several service organizations that he believes in and encourages you to give to either the Pat Tillman Foundation or an organization you connect with.  If we each give $10-20, our collective impacts will make a huge difference.

Resources:

Care behind the battlefield
Dustin Degman was featured in Asheville’s Mountain Express in 2013.

Podcast: Play in new window | Download